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Acute myocardial infarction: Cyclosporine, an immunosuppressant drug, does not improve outcomes after percutaneous coronary intervention


The immunosuppressant drug Cyclosporine did not improve clinical outcomes compared to placebo in patients receiving percutaneous coronary intervention ( PCI ) for the more severe form of heart attack known as ST-segment elevation myocardial infarction ( STEMI ).

Results of the CIRCUS trial showed that the drug, administered prior to PCI, had no impact on a composite of all-cause death, hospitalisation for - or worsening of - heart failure, or adverse left ventricular remodelling at one year.

There is substantial experimental evidence that Cyclosporine can reduce infarct size and improve cardiac function, and a small-size phase II trial suggested that Cyclosporine may reduce infarct size in STEMI patients ( N Engl J Med. 2008;359:473-81 ). Obviously, the larger phase III CIRCUS study did not confirm this, and the reason for this discrepancy in unclear.

The study included patients with anterior STEMI undergoing PCI within 12 hours of symptom onset and with complete occlusion of the culprit coronary artery. Patients were randomly assigned to receive a 2.5 mg/kg intravenous bolus injection of Cyclosporine ( n=395 ) or matching placebo ( n=396 ) before coronary recanalization.
The rate of the primary outcome was 59.0% in the Cyclosporine group versus 58.1% in the control group ( odds ratio, OR=1.04; P=0.77 ), and Cyclosporine also did not reduce the incidence of separate clinical components of the primary outcome or other events including recurrent infarction, unstable angina or stroke. ( Xagena )

Source: European Society of Cardiology ( ESC ) Meeting, 2015

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